Knee injuries

In this section we have collected information about common knee injuries such as anterior knee pain, meniscal tears, Anterior Cruciate Ligament tears, medial collateral ligament tears and Iliotibial Band Friction Sydrome (ITBFS).

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Anterior knee pain

This literally means pain in the front of the knee and is a very common complaint. There are several specific problems that can cause this and they vary from easily treatable to quite debilitating. It is important that you have your knee assessed if you suffer anterior knee pain, as a skilled physiotherapist will be able to diagnose your problem as well as address the underlying factors that may be causing your pain. They may send you for an Xray or ultrasound scan, or if they think you need more investigations they will refer you to see a sports physician or orthopaedic surgeon. The most common cause for pain in this area is to do with the patellofemoral joint (where your knee cap attaches to your leg). Several factors such as muscle weakness or tightness, poor running technique, or structural predisposition in the foot, knee or hip can cause misalignment of this joint. This leads to irritation within the joint and subsequent inflammation and pain. If ignored and left untreated this can lead to early wear and tear and ultimately arthritis. This is typically aggravated by running, hill walking or stair climbing. It may also be painful after prolonged sitting with the knee bent (so called movie-goers knee). Physiotherapy is usually the predominant form of treatment for this problem. Your physio will advise you on exercises to improve your muscle firing patterns, strengthen the weak muscles, stretch out the tight structures, and help improve your technique and training methods. Taping can be useful to help with the rehab, and they may also use massage or mobilisation of the knee cap. You may need orthotics if your foot biomechanics are a factor, your physio can refer you to a podiatrist if they feel you need custom made orthotics.

Other problems that cause anterior knee pain include patellar instability, fat pad inflammation, articular cartilage wear/damage, arthritis, patellar or quads tendon strains/tendinopathy, and bursitis (pre patellar or infrapatellar). There may be more than one cause of your pain and several of these conditions can co-exist. It is therefore important to get a thorough assessment done by a physiotherapist.

Meniscal tearsThe menisci are two C-shaped cartilages in the knee that act as shock absorbers and aid in movement of the knee. Acute meniscal tears are a common sports injury, usually caused by twisting the knee while your foot is planted on the ground. There are varying grades of injury from minor bruising to large unstable tears. Symptoms vary depending on severity but may include pain, swelling, difficulty to weightbear, painful clicking/clunking, giving way of the knee, or locking, where you are unable to straighten your knee. You can also have degenerative tears of your meniscus and these tend to happen in the middle aged patient and are not always caused by a significant accident. Minor tears and bruising will usually get better with appropriate rest and physiotherapy. Your treatment will be based around increasing your movement and decreasing your pain and swelling. Once you are improving it is beneficial to start some strengthening exercises including the use of an exercycle under the guidance of your physio.

If you have a more severe tear you are more likely to need arthroscopic (small camera inside your knee) surgery to fix the tear. In certain cases they will be able to sew the tear back together, but if your tear is not repairable then the surgeon will trim the tear down so that it is stable. After surgery you will require physiotherapy to regain the strength and movement in your knee before returning to your normal everyday life and sport. The length of rehabilitation will depend on what surgery you have had and how severe the injury was.

Anterior Cruciate Ligament tearsThe anterior cruciate ligament (ACL) is a ligament inside your knee joint that is important for knee stability. It stops the shin bone from moving too far forward in relation to your knee, and also stops excessive rotation of your knee. Tears of this ligament are a fairly common occurrence in sports such as rugby, hockey, netball, football (soccer), or skiing, as the mechanism of injury often involves the knee being twisted with the foot planted on the ground. An ACL tear is a significant injury, and is usually very painful, with a lot of swelling and restriction of movement afterwards. If your physio thinks you have injured your ACL they will usually refer you to see a sports physician or orthopaedic surgeon, as you will need to have your knee investigated further. This will involve Xrays and usually an MRI scan. Not all ACL tears will require surgery, so you may be advised to undertake a physiotherapy programme to strengthen the muscles of your knee. This will involve a progressive exercise programme to regain flexibility, strength and also the reflexes of your knee before you can return to sport. If your knee is functionally unstable or if you are a high level athlete then you will probably require an operation to rebuild the ligament. This requires a long period (6-9 months) of rehabilitation afterwards, and it is important to have guidance by an experienced physiotherapist during this time. They will be able to progress you through the various stages of your rehab to ensure you get back to sport as quickly as possible while remaining safe. Everybody’s knee will be different so your rehab should be tailored to your specific needs and speed of recovery.

Medial Collateral Ligament tearsThe medial collateral ligament (MCL) spans the medial or inner aspect of your knee and helps to stabilise the knee from sideways movement. Tears to this ligament often occur in rugby when tackled from the side while the foot is planted on the ground. They are also common in footballers (soccer players), either from a tackle or when the inside of the foot hits the ground forcing the knee inwards. MCL tears can also happen in conjunction with ACL tears and meniscal tears during a twisting injury. Isolated MCL tears will usually get better with appropriate rest and physiotherapy treatments. It is a good idea to adopt the R.I.C.E. principles in the early stages following this injury, and in severe cases a brace that limits your movement can be useful. As your pain settles and your movement improves your physio will give you exercises to strengthen the muscles around your knee and hip so that you are safe to return to sport. Physiotherapy may also involve joint mobilisations, massage and acupuncture to speed up the healing process.

Iliotibial Band Friction Sydrome (ITBFS)The Illiotibial Band or ITB is a thick band of fascia that extends from the pelvis, down over the outside of your leg and attaches just below the knee on the lateral (outer) aspect. ITBFS is a very common cause of knee pain, particularly in runners and cyclists. This happens when the ITB rubs over the underlying bone and becomes irritated and inflamed, causing pain on the outside of the knee. Physio is usually very effective at solving this problem, and will involve massage and stretching of the ITB and surrounding muscles, initial rest from painful activity, and correction of any muscle balance issues with strengthening exercises. Your physio will also advise you on footwear, training loads, and running technique if any of these factors may be contributing to your problem.